Frontline Caregivers Say State’s Mental Health System is Already in Shambles
Shortage of Beds and Lack of Funding Jeopardizes Patient Safety
Proposed Closing Will Be Devastating for the State’s Most Vulnerable Residents
Leading to Overcrowding of Emergency Rooms, Increased Homelessness and Suicide
BOSTON, MA – Last night the state’s House of Representatives failed to adopt a strong amendment preventing the closure of Taunton State Hospital, which also would have called for a comprehensive study of the growing mental health crisis in Massachusetts, opting instead to pass an anemic consolidated amendment that allows the closure of the 169-bed facility, while creating a scant 30 privatized beds somewhere in southeastern Massachusetts.
“We are shocked and dismayed by the House’s failure to respond to what can only be described as an abandonment of responsibility for the care of the mentally ill in Massachusetts,” said Karen Coughlin, a nurse at Taunton State Hospital, and vice president of the Massachusetts Nurses Association/National Nurses United. “We have no mental health care safety net in Massachusetts. There are not, and have not been, enough beds or services in the system for years. This decision will only exacerbate a long standing crisis, where every emergency department in the state is overcrowded with psychiatric patients waiting for days and even weeks for care. People will continue to go without care, crime will increase, homelessness will increase, more people will end up in the corrections system and many more will commit suicide.”
Taunton State Hospital is one of only six state operated mental health facilities in the state to care for people suffering from acute and chronic mental illness, including providing care to clients with a history of violence. If the closing goes forward, clients and families will be expected to travel 50 to 100 miles for care in Worcester or Tewksbury at facilities that are already over burdened. In addition the closure comes at a time when the state has lost more than 200 mental health inpatient beds, going from 834 beds in 2010 to the current total of 626 beds, also coming at a time when the state has slashed its mental health care spending more than any state in New England.
In announcing their decision, the state claims it will move 120 of the 169 beds to the new Worcester State Hospital, with the other 45 beds going to Tewksbury State Hospital. However, the decision to build the new Worcester State Hospital was made to compensate for the closure of Westborough State Hospital a number of years ago. Key Worcester area public officials have voiced opposition to the plan to close Taunton State and have affirmed that the opening of the new facility in Worcester was never intended to provide care to patients served by Taunton State Hospital
In southeastern Mass, opposition to the closing has been vocal and widespread, and includes opposition from city and town councils from communities throughout the region, local law enforcement officials, religious leaders and the Southeast and Cape Chapters of the Alliance for the Mentally Ill in Massachusetts.
“Their plan makes no sense,” Coughlin said. “Our system has been operating well over full capacity for years. We can’t provide the care people need even with our facility open. It’s a travesty.”
Coughlin’s claims are supported by the DMH itself, specifically in a report issued in June of 2011 by a Massachusetts Department of Mental Health Task Force on Staff and Client Safety. The Task Force was convened after the tragic murder of a DMH mental health worker at the hands of a client inappropriately placed in an understaffed group home. The report looked beyond that incident to the broader mental health system and its ability to provide safe, quality care to its clients.
The Task Force report clearly stated that the system was not serving the needs of the mentally ill. Below is a key section found on page 14 of the report:
The information we have received from numerous sources is the Commonwealth does not currently have a well-resourced and well-integrated system of services and treatment. This is in part the result of budget cuts that have significantly impacted the availability of services, including hospitalization and related resources.
The lack of resources impacts all levels of care, and deficiencies in any part of the system have ramifications throughout. For example, when DMH intermediate hospitals are filled to capacity (in part because there are insufficient placements in the community for individuals who are ready for discharge) and cannot accept timely transfer of individuals from acute care hospitals; this creates a “domino effect.” The acute care hospital resources then are stretched, making it more difficult for them to admit individuals into their care. This can lead to individuals being “boarded” in emergency department (ED) settings, sometimes for several days.
Currently, the system is fragmented. It must be strengthened in a way that effectively meets the needs of individuals receiving DMH funded services. A complete, well-resourced continuum of services is the only way to address the safety concerns that the Task Force heard from various stakeholders in public hearings and meetings.
One of the Task Force’s key recommendations was for the Commonwealth to “increase beds and services across the system as well as work with the complete continuum of care. Safety is compromised because the overall number of community based services/beds, acute hospital beds, and intermediate care beds do not meet the current demands.”
Again, nowhere in their own Task Force report, does the DMH sanction the closure of any bed or service, and in fact, the task force explicitly opposed any effort to compensate for one service by cutting another and emphasizes that a careful study should occur before the elimination of any service stating (on page 6), “Enhancing some services by diminishing others only moves the risks from one place to another. Thoughtful, thorough and public analysis of the likely consequences of changes in funding priorities should occur prior to any such moves. ”
The MNA/NNU, which represents nearly 100 RNs and health professionals who work at Taunton State Hospital, more than 1,800 staff who work throughout the state system, and more than 1,500 nurses working in the emergency departments and psychiatric units of 51 private sector acute care hospitals is committed to working with policy makers and elected officials to ensure that Massachusetts, which used to be a leader in the provision of mental health care, maintains its commitment to the most vulnerable residents of the Commonwealth. Efforts will now move to the state Senate where support has been strong for maintaining services at Taunton State Hospital and for a comprehensive study of the current crisis as recommended by the DMH Task Force report last year.
“This has gone beyond an issue of funding and finances,” Coughlin concluded. “This is a moral and ethical issue of human rights and common decency.”